Tendinopathy Thoughts
Time to build again. Let's go.
It's hard being injured. I've been struggling with both a lower hamstring tendinopathy and a compensatory achilles injury on the other side. On the whole, I've been really pleased with how this rehab block has gone. I have taken a different approach to my usual; it’s worked well, so I think it would be worth sharing.
The temptation is either to try to train through it or completely rest; unfortunately, I think neither of these approaches is helpful.
In my view, the key is load modification and specific strengthening. Not inactivity.
Your rehabilitation can be thought of as several distinct phases.
Rest and deload
There will be a short period where you'll have to rest. Catch it early, and you might get away with a short recovery. If it’s still causing problems, then it’s likely to be a longer process. Rest for maybe a week or two to allow the initial pain to settle. During this phase, keeping some non-weight-bearing aerobic work going, as long as it doesn’t seem to make things worse, is a good idea. It'll feel tight, but avoid the temptation to stretch it. Weakness is common; don’t worry.
Specific strengthening
Tendons are happiest when moving and loaded, but not too much. Loading will ease pain in the medium term, shorten recovery, and help to avoid future injury if continued. Start to focus on specific exercises that load the affected tendons. Slow repetitions, especially during eccentric (muscle lengthening) movements, are best, along with slow, heavy movements, depending on your injury. Do this both sides. Take advice from a good physio who has experience with your sport.
Functional Strengthening
Introduce small bouts of your activity early whilst continuing the specific strength work. Start to include some more dynamic movement as well. This will likely aggrevate the area, but it is key to recovery. Train and it will be sore, then rest until it settles and go again. Don't train unless it has settled to a 2-3 out of 10. This may be 24 hrs, 48 hrs or longer. The duration between sessions will gradually decrease, and you'll be able to slowly increase the volume and intensity. Tendon injuries usually feel better during a workout, but if the discomfort gets worse as you train, you should stop, rest, and try another time.
Back to Sport
Take it easy and be sensible. Build slowly and don't be in a rush. Your fitness will return quickly, but the soft tissues need time to catch up. Re-injury or a different niggle is common when building again, so try to avoid that. It will feel weird at first, but this will ease. Include intensity in this phase, too. It loads your body differently, and you will need time to adapt to faster, more intense efforts as well as volume. Ensure proper recovery; load, rest, and go again. Don't be afraid to take frequent breaks during sessions. It will allow your postural and core muscles to recover. If they get overloaded, your form may break down, and you risk injury again. Rest days are your friend so take plenty of them.
Other tips:
Try to work out why the injury happened in the first place. Too much load (volume or intensity), insufficient recovery, biomechanical issues, or perhaps a combination. Learn the lessons and make positive changes going forward.
Look after the mental side of things. It's tough not being able to practice your sport. There's more to life than that, but it still hurts. Find ways to still be active, do the things you couldn't get to whilst training, and spend time with family and friends. A Strava break may be necessary.
Very best of luck. See you on the other side; fitter and stronger!